The time interval between the onset of symptoms of myeloma and when a patient is actually diagnosed can take 3 months or longer, according to the results of a meta-analysis published in BMJ Open. The interval between when a patients starts feeling symptoms and treatment initiation is longer in myeloma than in any other cancer, said the researchers — and this longer diagnosis period is associated with a shorter period of disease-free survival.1
The systemic review was conducted using 9 studies published between 2009 and 2018 in the MEDLINE or Embase medical databases — and while the authors wrote that “no study reported the referral to diagnosis interval” directly, the investigators calculated the times themselves by subtracting the median length of primary care interval from the diagnostic interval. They acknowledged that because these times were not measured directly in the studies included in the analysis, their calculations of these intervals “should be interpreted with caution.”
The researchers, who hailed from the Nuffield Department of Primary Care Health Sciences at the University of Oxford, the Department of Hematology at the Oxford University Hospitals NHS Trust, and the National Institute for Health Research (NIHR) Biomedical Research Center Blood Theme in the United Kingdom, found that 25% of patients wait more than 98 days (3 months) from the appearance of symptoms to a positive diagnosis of myeloma. And following the first primary care visit, 25% of patients waited longer than 8 months for a confirmation of diagnosis.
Non-specific symptoms such as back pain and fatigue were blamed for why myeloma diagnoses can be missed, as well as general practitioner unfamiliarity with the disease and the fact that there is no gold standard established for myeloma screening.
- Koshiaris C, Oke J, Abel L et al. Quantifying intervals to diagnosis in myeloma: a systematic review and meta-analysis[published online June 22, 2018]. BMJ Open. doi: 10.1136/bmjopen-2017-019758